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General NPI Number Information
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NPI Number | 1366493678
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Entity Type | Individual
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Provider Name | DIEGO JOSE COVARRUBIAS MD
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Gender | Male
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Dates
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Enumeration Date | 05/12/2006
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Last Update Date | 09/24/2025
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Provider Practice Location Address
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Address Line | 3264 N EVERGREEN DR NE
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City | GRAND RAPIDS
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State | MI
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Zip | 49525-9746
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Country | US
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Telephone | 616-363-7272
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Fax | 616-361-5828
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Provider Business Mailing Address
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Address Line | 3264 N EVERGREEN DR NE
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City | GRAND RAPIDS
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State | MI
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Zip | 49525-9746
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Country | US
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Telephone | 616-363-7272
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Fax | 616-361-5828
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 24839
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License Number State | OR
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Taxonomy #2
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Taxonomy Code | 2085N0700X
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Taxonomy Name | Neuroradiology Physician
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License Number | 4301504400
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License Number State | MI
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Taxonomy #3
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Taxonomy Code | 2085N0700X
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Taxonomy Name | Neuroradiology Physician
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License Number | 61382258
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License Number State | WA
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Taxonomy #4
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Taxonomy Code | 2085N0700X
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Taxonomy Name | Neuroradiology Physician
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License Number | 0101287214
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License Number State | VA
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Taxonomy #5
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 4301504400
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License Number State | MI
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